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Purchase by Fax
     
Please make PO out to EZ Systems.  Note:  Pinnaclemicro's billing/invoices come from EZ Systems*

TO: EZ Systems*
3400 W MacArthur Blvd., #E
Santa Ana, CA 92704
Tel:714-662-4959 
Fax:714-662-6859 
http://www.ezsystems.com
My Email Address ?_______________________________

How did you find us ?__________________________

DATE:_______________________ Purchase Order Number:__________________ 

BILL TO:Company:_____________________________________CONTACT:__________________________________
Street Address: ____________________________________________________________________________________
City, State, Zip:_____________________________________________________________________________________

**BLIND SHIP** Yes or No

SHIP TO:Company:_________________________________CONTACT:_________________________________
Street address:_________________________________________________________________________________
City, State, Zip: ________________________________________________________________________________
Buyer Contact:_____________________Phone#:________________ext.________Fax#:____________________
Technical Contact:________________Phone#:__________________ext._______Fax#:_____________________

MFG PN# / Model Quantity Description Unit Price Total Warranty / Condition
           
           
           
           
           


Terms:_______ Credit Card#:___________________________Exp:_____Holder Name:_________________________

Shipping UPS or Fedx: _________________ Overnight:________ 2 Day:________ 3 Day:_______ Ground:________

My UPS / Fedx Account #:__________________Bill me Yes or No:______

COMMENTS:__________________________________________________________
____________________________________________________________________